Malaria prevalence and its determinants across 19 sub-Saharan African countries: a spatial and geographically weighted regression analysis

(2025) 24:305 Yitageasu et al. Malaria Journal https://doi.org/10.1186/s12936-025-05573-6 Malaria Journal Open Access RESEARCH Malaria prevalence and its determinants across 19 sub‑Saharan African countries: a spatial and geographically weighted regression analysis Gelila Yitageasu1*, Eshetu Abera Worede1, Eyob Akalewold Alemu2, Mitkie Tigabie3, Abebe Birhanu3, Abiy Ayele Angelo4, Mekuriaw Nibret Aweke5 and Lidetu Demoze1 Abstract Background Malaria remains a significant public health challenge, particularly in underdeveloped regions like subSaharan Africa, where environmental, housing, and socioeconomic factors drive its spread. This study aims to identify spatial patterns and key determinants of malaria infection among households across 19 sub-Saharan African countries to inform targeted interventions and policy strategies. Methods A community-based cross-sectional study was conducted using recent Demographic and Health Survey (DHS) data from 19 sub-Saharan African countries, encompassing 126,424 households and 11,594 clusters. Data processing including weighting, cleaning, and analysis was carried out using Microsoft Excel and Stata version 17. Prevalence estimates and 95% confidence intervals were generated in Stata, accounting for the DHS’s complex sampling design through the application of weights, clustering, and stratification. Spatial analyses, including cluster detection and Geographically Weighted Regression (GWR), Were conducted using ArcGIS version 10.7 and SaTScan™ version 10.2. Results Malaria prevalence among households in 19 sub-Saharan African countries was 22.47% (95% CI 22.24%, 22.70%), based on weighted estimates that account for the DHS sampling design. This indicates that approximately one in five households is affected by malaria. Spatial autocorrelation was significant (Global Moran’s I = 0.159; Z = 239.1; p < 0.001), confirming geographic clustering. Hot-spot analysis (Getis-Ord Gi*) highlighted hotspot zones in Benin, Burkina Faso, Togo, Uganda, Rwanda, parts of the Republic of the Congo, and Mozambique. SaTScan™ identified 34 statistically significant spatial clusters, with the most prominent situated in Ghana, Burkina Faso, Togo, and Benin; Anselin Local Moran’s I further revealed intermingled high and low-risk areas. Geographically Weighted Regression showed higher malaria prevalence in rural residents; households with rudimentary or natural roofs; younger heads of household; the poorest wealth quintile; no bed-net ownership, homes using treated bed nets, and large household size (6–12 members). Conversely, risk was lower in the richest households, those headed by women, and dwellings with natural or rustic walls. Conclusion Malaria remains highly prevalent (22.47%) in sub-Saharan Africa, with significant spatial clustering in countries like Benin, Burkina Faso, Togo, and Uganda. Key risk factors identified include rural residence, poor *Correspondence: Gelila Yitageasu Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Yitageasu et al. Malaria Journal (2025) 24:305 Page 2 of 30 housing conditions, lack of bed nets, homes using treated bed nets, and lower socioeconomic status. To reduce the burden, targeted interventions such as the distribution of insecticide-treated bed nets, indoor residual spraying, health education and improved housing should focus on identified hotspot areas. Collaboration among governments, NGOs, and local communities is essential to implement these strategies effectively and meet malaria reduction goals by 2030. Keywords Cluster, Malaria, Sub-Saharan Africa, Regression, Spatial Background Malaria continues to pose a significant public health threat worldwide, with its impact most severe in subSaharan Africa (SSA) [1]. The disease is endemic in over 100 countries and places nearly half of the global population at risk [2]. It is transmitted through the bite of infected female Anopheles mosquitoes, carrying one of five species of Plasmodium, among which Plasmodium falciparum is the most virulent, often resulting in severe complications and high mortality [3–5]. In 2023 the World Health Organization reported 263 million cases and 597 000 deaths worldwide, with Africa bearing 94% of cases and 95% of deaths [6]. A recent multilevel analysis of 13 national Malaria Indicator Surveys in SSA, involving over 60,000 children aged 6–59 months, reported a pooled malaria prevalence of 27.4%, with national rates ranging from 5% in Senegal to over 62% in Sierra Leone [7]. Furthermore, over half of the region’s malaria burden is concentrated in six countries such as Nigeria, the Democratic Republic of the Congo, Uganda, Mozambique, Angola, and Burkina Faso illustrating the disproportionate and persistent nature of the disease in the region [8]. Despite the progress gained in reducing malarial morbidity and mortality, the disease remains a major public health problem in many countries of SSA. This emphasizes how malaria is a public health concern in SSA. In SSA, malaria transmission remains elevated in part due to the growing spread of insecticide resistance in major vectors like Anopheles gambiae and Anopheles funestus. Pyrethroid-resistant mosquito populations have been documented across West, East, and Central Africa, with resistance intensity regularly surpassing WHO thresholds (< 90% mortality) in countries such as Kenya [9], Ghana [10], and the Democratic Republic of the Congo [11]. For example, coastal Kenya has reported low mosquito mortality rates to permethrin and deltamethrin in multiple An. gambiae sites [9], and southern regions of Ghana have seen escalating resistance in An. gambiae and An. funestus that compromise the efficacy of longlasting insecticidal nets [10]. This widespread resistance diminishes the lethality of insecticide-treated nets and indoor residual sprays, leading to more mosquito bites, higher parasite transmission, and persistent malaria preva (...truncated)